Implementation of a Sense of Home in High-Density Multicultural Singapore Nursing Homes: Challenges and Opportunities
Abstract
:1. Introduction
2. Literature Review
2.1. Environmental Aspects of a Sense of Home in Nursing Homes
2.2. Living Environments in Singapore
3. Materials and Methods
3.1. Five Nursing Homes in Singapore
3.2. Participant Observation
3.3. Focus Group Interviews
3.4. Data Analysis
4. Results
4.1. Room-in-Room in Shared Bedrooms
4.2. Personalization in Niche Spaces
4.3. Personal Zone in a Common Room
4.4. Institution Workflows over Personal Choices
“For me, it’s okay. Because I’m not so fussy about that, because they [staff] have to, you know, find a time for me.”—A female resident in NH4.
4.5. Homelike Veneer in a Common Room
4.6. Bringing the Neighborhood Scenes Indoors
4.7. Visual Stimuli Provided but Other Senses Neglected
4.8. Access to Urban Nature and Outdoor Spaces
4.9. Voluntary Creation of Communal Experiences
4.10. Turning a Family Visit into a Shared Experience
5. Discussion
5.1. Privacy Management and Territoriality in the Shared Space
5.2. Holistic Implementation of Homelike Environments
5.3. Pivotal Role of Communal Experiences
5.4. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Themes | Recommendations | Key References |
---|---|---|
Private spaces | Private rooms allow residents an opportunity to withdraw and be on their own and to create their own environment by having control over space. | Van Hoof et al. [2], Hauge and Heggen [4], Nakrem et al. [5], Eijkelenboom et al. [11], de Veer and Kerkstra [21], van Hoof et al. [19], Falk et al. [22] |
Private rooms allow residents to be able to receive visitors. | Van Hoof et al. [2] | |
Access to a private bathroom offers residents a sense of control and privacy during personal care activities. | Fleming et al. [13], van Hoof et al. [19], Klaassens and Meijering [23] | |
Furniture in private spaces, meant to accommodate residents’ visitors. | Eijkelenboom et al. [11] | |
Personal belongings | Residents’ personal belongings such as cherished items and furniture create a semblance of familiarity. | Fleming et al. [13], van Hoof et al. [19], Board and McCormack [24] |
Sufficient space to store and display personal items. | Van Hoof et al. [2] | |
Storage space for personal items. | Eijkelenboom et al. [11] | |
Ambience | Evoke a sense of warmth and coziness through strategies such as having access to daylight, with homelike furniture, decorations and homelike smells. | Van Hoof et al. [2], Eijkelenboom et al. [11], Fleming and Purandare [12], Board and McCormack [24] |
Reserved spaces in communal spaces, such as having their own spot at the dining table, or a private chair in a preferred spot. | Van Hoof et al. [2], Eijkelenboom et al. [11], van Hoof et al. [19] | |
Accommodate lower-density spaces within the larger units | Van Hoof et al. [2], Eijkelenboom et al. [11] | |
Location in a familiar neighborhood or hometown. | Eijkelenboom et al. [11], Board and McCormack [24] | |
Appropriate levels of stimulation | Provide activities that promote pleasure and appropriate levels of stimulation, according to the resident’s needs and abilities. | Van Hoof et al. [2], Fleming et al. [13], Fleming and Purandare [12] |
Provide a variety of spaces to suit different functions and preferences (e.g., having quiet spaces to retreat to when someone else is watching TV). | Fleming and Purandare [12] | |
Connection with nature | Physical and visual access to outdoor and green spaces with fresh air and sun enables connection to the outside world. | Van Hoof et al. [2], Nakrem et al. [5], van Hoof et al. [19] |
Animal life (e.g., birds or fish) provides a welcomed distraction for residents. | Van Hoof et al. [2], van Hoof et al. [19] | |
Social interactions | Supporting engagement in everyday homelike activities invites residents and their families to be involved in everyday life. | Robinson et al. [16], van Zadelhoff et al. [18] |
Comfortable spaces conducive to engagement and interaction with other residents, family and visitors. | Van Hoof et al. [2], Falk et al. [22] |
NH1 | NH2 | NH3 | NH4 | NH5 | |
---|---|---|---|---|---|
Site area (sqm)/Number of stories | 4830/ 11 stories | 2800/ 12 stories | 3000/ 9 stories | 2991/ 6 stories | 9056/ 3 buildings: (1), (2) and (3), each 3 stories high |
Bedroom type | 4 beds | 9 beds and 4 beds | 8 beds | 6 beds | (1) 8 beds (2) 5 beds (3) 2 beds |
Typical bedroom size (sqm) | 36 | 85 | 64 | 90 | (1) 54 (2) 50 (3) 20 |
Beds occupied/ Total capacity | 343/392 | 560/600 | 203/225 | 218/230 | 190/190 |
Types of residents * | Cat I: 0 Cat II: 27 Cat III: 198 Cat IV: 118 | Cat I: 0 Cat II: 14 Cat III: 318 Cat IV: 228 | Cat I: 0 Cat II: 5 Cat III: 103 Cat IV: 95 | Cat I: 1 Cat II: 6 Cat III: 83 Cat IV: 128 | Cat I: 0 Cat II: 0 Cat III: 128 Cat IV: 162 |
Ethnicity of residents | Chinese: 87.1% Malay: 8.9% Indian: 4% Others: 0% | Chinese:96% Malay: 0% Indian: 4% Others: 0% | Chinese: 61.3% Malay: 24.7% Indian: 12.9% Others: 1.1% | Chinese: 88% Malay: 4% Indian: 8% Others: 0% | Chinese: 60% Malay: 10% Indian: 24% Others: 6% |
Unit type | Household: 4 rooms × 4 beds | Ward-wing: 4 rooms × 8 beds (plus 1 room × 4 beds (haze room)) | Ward-floor: 6 rooms × 8 beds | Ward-floor: 9 rooms × 6 beds | Ward-floor cluster: (1) 8 rooms × 8 beds (2) 6 rooms × 5 beds (3) 8 rooms × 2 beds |
Residents per unit | 16 | 36 | 48 | 54 | (1) 64 (2) 30 (3) 16 |
Staff per unit | 5 (plus 1 shared staff member between units) | 15 to 17 | 10 | 18 to 20 | 60 |
NH1 | NH2 | NH3 | NH4 | NH5 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Total Residents Recruited | 101 | 29.5% | 99 | 17.7% | 95 | 46.8% | 100 | 45.9% | 100 | 52.6% | |
Participant’s age group | <40 | 0 | 0% | 0 | 0% | 1 | 1.1% | 0 | 0% | 0 | 0% |
40–50 | 3 | 3% | 1 | 1% | 3 | 3.2% | 1 | 1% | 3 | 3% | |
51–60 | 7 | 6.9% | 2 | % | 12 | 12.6% | 2 | 2% | 13 | 13% | |
61–70 | 17 | 16.8% | 22 | 22.2% | 18 | 19% | 17 | 17% | 18 | 18% | |
71–80 | 31 | 32.7% | 26 | 42.4% | 29 | 28.4% | 33 | 31% | 27 | 32% | |
81–90 | 33 | 32.7% | 42 | 42.4% | 27 | 28.4% | 31 | 31% | 32 | 32% | |
91–100 | 9 | 8.9% | 6 | 6.1% | 5 | 5.3% | 12 | 12% | 7 | 7% | |
>100 | 1 | 1% | 0 | 0% | 0 | 0% | 2 | 2% | 0 | 0% | |
Unknown | 0 | 0% | 0 | 0% | 0 | 0% | 2 | 2% | 0 | 0% | |
Participant’s length of stay(years) | 0 | 19 | 18.8% | 35 | 35.4% | 65 | 68.4% | 20 | 20% | 40 | 40% |
1–3 | 50 | 49.5% | 37 | 37.4% | 29 | 30.5% | 37 | 37% | 27 | 27% | |
4–6 | 23 | 22.8% | 18 | 18.2% | 0 | 0% | 18 | 18% | 15 | 15% | |
7–10 | 5 | 5% | 8 | 8.1% | 0 | 0% | 11 | 11% | 9 | 9% | |
>10 | 4 | 4% | 1 | 1% | 0 | 0% | 11 | 11% | 9 | 9% | |
No data | 0 | 0% | 0 | 0% | 1 | 1.1% | 3 | 3% | 0 | 0% | |
Participant’s RAF category | Cat II | 7 | 6.9% | 2 | 2% | 5 | 5.3% | 0 | 0% | 0 | 0% |
Cat III | 62 | 61.4% | 80 | 80.8% | 66 | 69.5% | 41 | 41% | 29 | 29% | |
Cat IV | 32 | 31.7% | 14 | 14.1% | 24 | 25.3% | 59 | 59% | 71 | 71% | |
Participants ethnicity | Chinese | 88 | 87.1% | 95 | 96% | 59 | 62.1% | 88 | 88% | 60 | 60% |
Malay | 9 | 8.9% | 0 | 0% | 23 | 24.2% | 4 | 4% | 24 | 24% | |
Indian | 4 | 4% | 4 | 4% | 12 | 12.6% | 8 | 8% | 10 | 10% | |
Others | 0 | 0% | 0 | 0% | 1 | 1.1% | 0 | 0% | 6 | 6% | |
Participants gender | Male | 61 | 60.4% | 44 | 44.4% | 53 | 55.8% | 48 | 48% | 54 | 54% |
Female | 40 | 39.6% | 55 | 55.6% | 42 | 44.2% | 52 | 52% | 46 | 46% | |
Diagnosed with dementia | Yes | 42 | 41.6% | 61 | 61.6% | 28 | 29.5% | 56 | 56% | 59 | 59% |
No | 59 | 58.4% | 38 | 38.4% | 67 | 70.5% | 44 | 44% | 41 | 41% | |
Ability to communicate | Yes | 93 | 92.1% | 95 | 96% | 93 | 97.9% | 86 | 86% | 100 | 100% |
No | 8 | 7.9% | 4 | 4% | 2 | 2.1% | 14 | 14% | 0 | 0% |
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Lee, J.-J.; Ng, T.P.; Nasution, I.K.; Eng, J.Y.; Christensen, R.D.; Fung, J.C. Implementation of a Sense of Home in High-Density Multicultural Singapore Nursing Homes: Challenges and Opportunities. Int. J. Environ. Res. Public Health 2022, 19, 6557. https://doi.org/10.3390/ijerph19116557
Lee J-J, Ng TP, Nasution IK, Eng JY, Christensen RD, Fung JC. Implementation of a Sense of Home in High-Density Multicultural Singapore Nursing Homes: Challenges and Opportunities. International Journal of Environmental Research and Public Health. 2022; 19(11):6557. https://doi.org/10.3390/ijerph19116557
Chicago/Turabian StyleLee, Jung-Joo, Tse Pei Ng, Ivan Kurniawan Nasution, Jia Yen Eng, Renee Desneige Christensen, and John Chye Fung. 2022. "Implementation of a Sense of Home in High-Density Multicultural Singapore Nursing Homes: Challenges and Opportunities" International Journal of Environmental Research and Public Health 19, no. 11: 6557. https://doi.org/10.3390/ijerph19116557